Abstract ES2-1: Assessing the older adult with breast cancer for treatment: Whom, why, when and how?

Abstract

Abstract Breast cancer is primarily a disease of aging, with over 40% of breast cancers diagnosed in individuals age 65 and older. A key aspect of personalized medicine is to understand the risks and benefits of therapy for the individual. This process involves gaining a deeper understanding of an older adult's functional age in order to weigh the risks and benefits of therapy and to make treatment decisions in the context of the patient's preferences, goals, and values. A geriatric assessment can be utilized to understand an older adult's functional versus chronological age, as well as to identify the risk of chemotherapy toxicity and overall life expectancy (1). This assessment includes an evaluation of the following domains which are predictive of the risk of morbidity and/or mortality in older adults: functional status, comorbidity, cognition, psychological state, social support, nutritional status, and polypharmacy. The geriatric assessment identifies areas of vulnerability which can guide targeted interventions to assist the older adult undergoing cancer therapy. Barriers to the inclusion of a geriatric assessment in oncology practice include the time needed to complete the assessment. A primarily self-administered version of the geriatric assessment has been developed and is available online at the Cancer and Aging Research Group website (http://www.mycarg.org/SelectQuestionnaire). The assessment has been pilot tested in cooperative group trials as well as among patients receiving standard of care chemotherapy (2,3). These studies demonstrated that the majority of patients are able to complete the patient portion of the assessment on their own and are satisfied with the assessment length and content. Hence, it is feasible to capture geriatric assessment information in oncology practice. Studies have demonstrated the utility of a geriatric assessment in predicting the risk of chemotherapy toxicity among patients with all tumor types (3-5). An ongoing study in older adults receiving adjuvant treatment for breast cancer is evaluating the association between geriatric assessment variables, biomarkers of aging, and reduced relative dose intensity (RDI) of the prescribed chemotherapy regimen (ClinicalTrials.gov ID: NCT01472094). In this lecture we will discuss the key aspects of a geriatric assessment for older adults with breast cancer in order to facilitate individualized treatment decision making.